Risk Assessment In Patients Research Articles

Environmental contamination with SARS-CoV-2 in nursing homes.

BackgroundSARS‐CoV‐2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID‐19) units within NHs to care for affected patients. Frequency and persistence of SARS‐CoV‐2 environmental contamination in these units have not been studied.MethodsA prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high‐touch surfaces in COVID‐19‐infected patient rooms were obtained at enrollment and follow‐up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS‐CoV‐2 RNA detection from specific environmental surfaces in COVID‐19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS‐CoV‐2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site‐specific environmental detection upon enrollment and during follow‐up.ResultsOne hundred and four patients with COVID‐19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non‐Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3‐month study period, 2087 swab specimens were collected (1896 COVID‐19 patient rooms, 191 common areas). SARS‐CoV‐2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS‐CoV‐2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow‐up. Functional independence increased the odds of proximate contamination.ConclusionsEnvironmental detection of viral RNA from surfaces in the rooms of COVID‐19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.

Trends and outcomes of acute pulmonary embolism transfers: a nationwide cohort sample 2008–2018

Abstract Background Acute pulmonary embolism (PE) is associated with a high morbidity and mortality. There is paucity of data describing outcomes of patients with PE transferred from a different acute care hospital. We hypothesized that outcomes of patients transferred for PE care may be suboptimal potentially as a result of treatment delays due to non-protocolized transfer plan for this cohort of patients. Methods We used the Nationwide Inpatient Sample (NIS) from 2008–2018 to identify patients hospitalized with a primary diagnosis of acute PE by using International Classification of Diseases-9th, and 10th revision-clinical modification codes. Patients were subgrouped according to the transfer status by using the NIS transfer data element. The primary outcome was in-hospital mortality. The secondary outcomes were the annual trends of PE transfers and in-hospital mortality over study period. Chi-square test was used to compare categorical variables while Mann-Whitney U test was used for continuous variables. A multivariate logistic regression model of clinically relevant variables including hypertension, diabetes mellitus, atrial fibrillation, heart failure, coronary artery disease, chronic lung disease, chronic kidney disease, length of stay, age, and gender were conducted for the primary outcome. Results A total of 396,214 patients with an acute PE met inclusion criteria. Among this patient cohort, 8.1% of patients were transferred from an outside facility. Patients that were transferred for PE management were older [median age 66.0 years (interquartile range (IQR), 49–83) vs 64.0 (IQR, 48–80) years, p<0.001], had longer length of stay [median 5.0 (IQR, 1–9) days vs 4.0 (IQR, 1–7) days, p<0.001], and had a higher number of comorbidities. The in-hospital mortality among PE transfers was higher compared to those that were not transferred (5.7% vs 2.8%, p<0.001). After adjustment using multivariate regression model, transfer for PE care was associated with increased risk of mortality (odds ratio 1.8 (95% confidence interval, 1.1–2.9; p=0.013). Transfers for PE care notably increased over the study period (5.8% in 2008 to 11.3% in 2018, p<0.001). Trends of in-hospital mortality among PE transfers did not change over time while there was a decrease in mortality among patients that were not transferred for management of their PE (3.2% in 2008 to 2.6% in 2018, p<0.001). Conclusion Patients transferred for PE care tend to be more complex and have a higher risk of mortality relative to patients that do not require transfer of care. Despite the increased transfer rate of PE patients over time, the mortality rates have not improved. Further prospective research should evaluate the characteristics of treatment and further assess patient risk to help develop transfer protocols that may reduce risk for patients with PE requiring higher acuity care. Funding Acknowledgement Type of funding sources: None.

A Scoping Review of Emergency Department Discharge Risk Stratification.

IntroductionAlthough emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge.MethodsWe conducted a literature search to explore how EDs assess patient risk upon discharge, including a review of PubMed and gray literature. After independently screening articles for inclusion, we recorded study characteristics including outcome measures, patient risk factors, and tool descriptions. Based on this review and discussion among collaborators, major themes were identified.ResultsPubMed search yielded 384 potentially eligible articles. After title and abstract review, we screened 235 for potential inclusion. After full text and reference review, supplemented by Google Scholar and gray literature reviews, we included 30 articles for full review. Three major themes were elucidated: 1) Multiple studies include retrospective risk assessment, whereas the use of point-of-care risk assessment tools appears limited; 2) of the point-of-care tools that exist, inputs and outcome measures varied, and few were applicable to the general ED population; and 3) while many studies describe initiatives to improve the discharge process, few describe assessment of post-discharge resource needs.ConclusionNumerous studies describe factors associated with an increased risk of readmission and adverse events after ED discharge, but few describe point-of-care tools used by physicians for the general ED population. Future work is needed to investigate standardized tools that assess ED discharge risk and patients’ needs upon ED discharge.

How we ask matters: The impact of question wording in single-item measurement of suicidal thoughts and behaviors

The present study aimed to extend prior literature on single-item assessment by examining response consistency (1) between several commonly used single-item assessments of suicidal ideation, planning, and attempts, and (2) across three timeframes (past month, past year, and lifetime) commonly employed in the literature. Participants (N = 613) were recruited from an online community, Amazon Mechanical Turk (mTurk). Participants were administered three sets of four distinct single-items assessing suicidal ideation, suicidal planning, and suicide attempt history, respecitvely. Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey; World Health Organization Mental Health Survey Initiative, Youth Risk Behavior Survey) and commonly used suicide risk assessments (i.e., Self-Injurious Thoughts and Behaviors Interview). Through examinations of intraclass correlations and confirmatory factor analyses, findings suggested mixed response agreement across most outcomes and timeframes. Response inconsistency among items assessing suicidal ideation and among items assessing suicidal planning were partly attributed to minor, yet important, language differences. Given findings that even minor language changes in suicidal ideation and planning items may inflate or restrict prevalence estimates in a meaningful way, it will be important for researchers and clinicians alike to pay close attention to the wording of single items in designing research studies, interpreting findings, and assessing patient risk.

Utility of Ariscat (Assess Respiratory Risk in Surgical Patients in Catalonia) Score in Predicting Postoperative Pulmonary Complications in Patients Undergoing Elective/Emergency Surgery in a Tertiary Care Hospital in India

Introduction: Postoperative pulmonary complications (PPCs) account for a substantial proportion of risk related to surgery and anesthesia and are a major cause of postoperative morbidity, mortality and longer hospital stays. Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score is a risk prediction model developed for predicting PPCs. Objectives: To calculate the Sensitivity, Specificity of ARISCAT score in predicting postoperative pulmonary complications in patients undergoing Elective/Emergency surgery in a tertiary care hospital in India and to find out the incidence of postoperative pulmonary complications in various surgeries. Materials and Methods: Study Site: Apollo Main Hospital, Greams Road, Chennai. Study Design: Prospective Observational Study. Study Period: September 2018 to March 2019. Sample Size: Three hundred and thirty cases (330). Methodology: Patients undergoing non-Obstetric Elective or Emergency surgical procedure under general, neuraxial or plexus block anaesthesia were recruited through simple random sampling technique. After taking informed written consent, demographic details and clinical history were collected. Risk for post-operative pulmonary complications was assessed based on ARISCAT score. These patients were followed in the post-operative period till discharge to look for the following postoperative pulmonary complications −1. Respiratory failure 2. Pulmonary infection 3. Pleural effusion 4. Atelectasis 5. Pneumothorax 6. Bronchospasm 7. Aspiration pneumonitis. Results: The incidence of postoperative pulmonary complications in this study was 9.4%. The incidence of postoperative pulmonary complications in peripheral surgeries, upper abdominal and intrathoracic surgeries was 2.9 %, 14.1 % and 55.6 % respectively. The Sensitivity, Specificity, PPV and NPV of ARISCAT score were 83.9 %, 80.3 %, 30.6 % and 98 % respectively. Conclusion: ARISCAT score can be used as a routine screening tool for predicting the risk of developing PPCs.

Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors

Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on hospital length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to potential for prolonged length of stay and postoperative complications, it is important to better understand the factors that increase the risk of these outcomes in patients with IMSCTs. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factors influencing prolonged length of stay and post-op complications. ResultsA total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above (OR 1.89; p = 0.0005), dependent functional status (OR 2.76; p = 0.0035) and transfer from facilities other than home (OR 8.12; p <0.0001) were independent predictors of prolonged length of stay (>5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). ConclusionOur study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.

Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation

BackgroundTobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review.ObjectiveThis study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics.MethodsThis is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation.ResultsClinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups.ConclusionsClinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care.

Monitoring Prediabetes Screening in Two Primary Care Offices in Rural Appalachia: A Quality Improvement Process.

One-third of the U.S. population has prediabetes, but 90% remain undiagnosed because healthcare providers are not screening for this condition. The purpose of this quality improvement project was to monitor prediabetes screening and identification, and implement evidence-based recommendations including registered dietician referral. This project involved using an evidence-based screening tool to measure individual risk of prediabetes. Aggregate data was collected to evaluate screening implementation, evidence-based recommendations offered by providers, and assess patient risk factors. The percentage of patients at risk for prediabetes was 41.3% (n = 111). The most frequent risks were identified as overweight, history of hypertension, family history of type 2 diabetes mellitus (T2DM), and older age. Providers offered education on weight loss 68.5% (n = 76) and exercise 76.6% (n = 85) but referred 33.3% (n = 37) patients for nutrition education. The screening rates were 52.3% (n = 176) and 72.5% (n = 244) in clinics A and B respectively. A gap remains in using evidence-based recommendations to decrease risk of prediabetes. Prediabetes screening identified a greater percentage of persons in this population. There is a need for consistent practice of evidence-based recommendations. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery

Presenter: Djhenne M Dalmacy MS | The Ohio State University Background: Regionalization of hepatopancreatic (HP) surgery to high-volume hospitals has been associated with fragmentation of post-discharge surgical care and, in turn, inferior outcomes. The objective of the current study was to assess whether patient social vulnerability was associated with the chance of fragmented postoperative care following HP surgery. Methods: Medicare beneficiaries who underwent HP surgery and had at least one readmission within 90 days were identified using Medicare 100% Standard Analytical Files from 2013 to 2017. Patients were categorized into four groups based on their social vulnerability level (i.e. low, low-moderate, moderate-high, and high). Fragmented postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index (SVI) and the individual components comprising SVI [Socioeconomic, Household Composition & Disability (HC & Disability), Minority Status & Language (MS & Language), Housing Type & Transportation (HT & Transportation)] with fragmentation of postoperative care was examined using multivariable logistic regression analysis. Results: Among 11,142 patients who met the inclusion criteria, 8,053 (72.3%) had undergone pancreatectomy, while 3,089 (27.7%) had undergone hepatectomy. The overall incidence of fragmented care was 32.9% (n = 3,667). Patients who had fragmented care were older (fragmented: 73 years [IQR: 69-77] vs. 72 years [IQR: 68-77]) and had a higher comorbidity score (fragmented: 4 [IQR: 2-8] vs. non-fragmented: 3 [IQR: 2-8]) (both p<0.001). Median overall SVI was higher among patients who received fragmented care (fragmented: 52.5 [IQR: 29.3 – 70.4] vs. non-fragmented: 51.3 [IQR: 27.9 – 69.4], p = 0.03). When examining each of the components comprising SVI, patients who received fragmented care had higher socioeconomic index (fragmented: 52.5[IQR: 29.3-70.4] vs. non-fragmented: 51.3 [IQR: 27.9-69.4]), higher HC & disability index (fragmented: 41 [IQR: 22.1-59.8] vs. non-fragmented: 39.3 [IQR: 19.4-57.4]) and lower MS & language index (fragmented: 76.3 [IQR: 54.5-90.3] vs. non-fragmented: 78.4 [IQR: 58.6-91.4]) (all p<0.05). On multivariable analysis, odds of receiving fragmented care were higher among patients with high socioeconomic vulnerability (referent low; OR: 1.24; 95% CI: 1.11 – 1.39), high HC & Disability (OR: 1.30; 95% CI: 1.16 – 1.46; p<0.001), whereas high MS & Language vulnerability was inversely associated with receipt of fragmented postoperative care (OR: 0.84; 95% CI: 0.75 – 0.94; p = 0.002) (Figure 1a). The possibility of fragmented care increased with increasing overall SVI (high vs low SVI; OR: 1.12; 95% CI: 1.01 – 1.26; p = 0.04) (Figure 1b). Conclusion: Approximately one-third of Medicare beneficiaries had fragmented postoperative surgical care following HP surgery. Social vulnerability was strongly associated with the chance of receiving fragmented postoperative care. Social determinants of health including social vulnerability should be considered when assessing patient risk of fragmented care after HP surgery.

Atrial fibrillation and stroke prevention: state of the art-epidemiology and pathophysiology: new risk factors, concepts and controversies.

Atrial fibrillation (AF) increases the risk of thromboembolism, and risk assessment for thromboembolism is necessary for the management of AF patients. CHADS2 and CHA2DS2-VASc scores have been adopted in international guidelines for AF management, but the significance of each risk factor included in these risk scores are sometimes controversial, and the performance of these scores is only modest. There are several other risk factors not included in the scores such as renal dysfunction, low body weight, type of AF (paroxysmal or non-paroxysmal) as well as echocardiographic parameters and blood biomarkers, and physicians should assess patients risk in an integrated manner.

Predicting Fracture Healing with Biomarkers: The Potential for Precision Medicine to Assess Patient Risk of Fracture Nonunion

Objective: &#x0D; To provide a comprehensive survey of the literature related to the current efficacy of biomarkers for predicting fracture healing. &#x0D; Methods: &#x0D; EMBASE and PubMed, were searched using the following terms: fractures, biomarkers, ununited, and nonunion with the assistance of a medical librarian. The initial search yielded 199 records. Additional search of Google Scholar and review of the references yielded zero additional records. The 165 unique records were screened, of which 105 were excluded due to experimental treatments, non-fracture related bone healing, animal studies, and study group design failure to compare union versus nonunion fracture outcomes. This left 21 articles for full review. &#x0D; Results: &#x0D; 19 serum biomarkers were reviewed for nonunion predicative capability. From this cohort 9 biomarkers had promising results including; bone formation markers OC and PINP, bone resorption markers TRAP and OPN, growth factors VEGF and PGF-1, TEMRA and TReg cells, and miR-193a-3p. 15 SNPs on 11 genes were examined. The polymorphisms with the greatest potential for increased risk of nonunion based on odds ratio include; SMAD6 rs2053423 T/T genotype OR = 10.27. IL-1b rs2853550 T allele OR = 5.9. NOG rs1372857 G/G genotype OR = 4.56. NOS rs2297514 OR = 3.98. and PDGF CCG haplotype OR = 3.57 &#x0D; Conclusion: &#x0D; There remains an unmet clinical need to develop predictive parameter(s) for bone healing that are objective, reproducible, preferably continuous, unique to the individual, and optimally based on a readily accessible biologic measurement. Ultimately yielding a biomarker predictive of future nonunion that is additive, or superior, to that of known clinical risk factors for nonunion. &#x0D; Clinical Implications: &#x0D; Accurate biomarkers could identify patients at early times post-injury who may benefit from intervention to promote healing, thus circumventing unnecessary delays in nonunion intervention. Additionally, biomarkers could eliminate preemptive surgery in patients with early slow progression who are otherwise on a healing trajectory.

Venous Thromboembolism and D-dimer In Patients with COVID-19

Background and Hypothesis: The potential association between venous thromboembolism (VTE) and COVID-19 is an area of growing research, and methods of effective prophylaxis, detection, and treatment continue to be sought. D-dimer assays have been previously established as a highly sensitive — albeit nonspecific — test to assess patient risk of VTE, but the full clinical utility of this test in COVID-19 patients is currently not well understood. We hypothesized that, in patients presenting to the emergency department (ED) and determined to be positive for COVID-19, an elevated D-dimer value is associated with an increased 30-day incidence of VTE. &#x0D; &#x0D; Project Methods: Deidentified patient encounter data was collected and analyzed from a multicenter registry of ED patients tested for SARS-CoV-2. We measured the frequency of a positive SARS-CoV-2 test and compared the incidence of VTE between SARS-CoV-2 positive and negative patients. We also compared average D-dimer values in SARS-CoV-2 positive patients with and without VTE. &#x0D; &#x0D; Results: Of 6,445 patient encounters queried, 2,051 tested positive for SARS-CoV-2 (32%). &#x0D; SARS-CoV-2 positive patients had a significantly higher incidence of VTE in the 30-day follow-up period compared to SARS-CoV-2 negative patients (3.2 vs. 1.6%, p= 0.0002). D-dimer values were available for 537 of these SARS-CoV-2 patients, with an average D-dimer of 1813.83 ng/mL. The average D-dimer in SARS-CoV-2 positive patients who did develop VTE tended to be higher than those who did not develop VTE (2969 ng/mL vs. 1822 ng/mL), although this difference was not statistically significant (p=0.34). The fitted areas for binomial receiver operating characteristic curves of D-dimer for detection of VTE in patients with and without SARS-CoV-2 were 0.628 and 0.829, respectively. &#x0D; &#x0D; Conclusion and Potential Impact: We found a positive SARS-CoV-2 test to be associated with a higher incidence of VTE. However, an elevated D-dimer continues to be nonspecific for VTE in SARS-CoV-2 positive patients, and performs more poorly in SARS-CoV-2 positive patients than in negative patients. Additional clinical criteria should be identified to further guide the use of diagnostic imaging modalities and prophylactic anticoagulation in COVID-19 positive patients with suspicion of VTE.

Post-Operative Opioid Prescribing Practices and Trends Among Urology Residents in the United States.

Introduction: With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States.Methods: Urology residents were sent a 16-question survey regarding opioid prescribing patterns, influencing factors, opioid training experience, and amounts of opioids prescribed for common urologic procedures.Results: One hundred and four urology residents participated in the survey (75% male and 25% female). Common factors influencing opioid prescribing were standard prescribing practice for certain operations (80%), attending/senior resident preference (62.1%), and immediate post-operative pain (54.7%). Residents reported prescribing more opioids at discharge for open abdominal and robotic procedures (167.9 and 134.2 morphine milligram equivalents, MME, respectively) and lower amounts for outpatient surgeries (39.7 and 55.8 MME for vasectomy and transurethral resections). Only 15.5% of residents utilize any formal algorithm for post-operative opioid prescribing at their institution. Further, 51.6% of residents received no formal education on safe opioid prescribing during residency, and only 42.1% routinely assess patient risk for opioid abuse. Urology residents who received formal opioid training prescribed less opioids on average for common urologic procedures compared to those who had not trained.Conclusions: This study highlights the importance of increasing resident education on opioid prescribing during residency training, as well as an opportunity for the implementation of standardized post-operative opioid prescribing regimens to help improve trends in urology resident opioid prescribing.

Abstract 15306: Annual Transplant Volume Does Not Affect Center Specific Mortality- A PHTS Database Study

Introduction: Recent studies have suggested a relationship between mortality and center volume in pediatric heart transplantation; however, these studies utilize databases that lack granularity to assess patient risk profiles. Hypothesis: Utilizing the Pediatric Heart Transplant Society (PHTS) database, we hypothesized that there would be a difference in outcomes among centers based on yearly transplant volume, and that the patient’s clinical profiles would differ by center volume. Methods: We performed a retrospective analysis of the PHTS dataset from all pediatric (≤ 18 years of age) cases from 2009-2018. Centers were stratified into 5 groups based on annual volume: ≤ 4, 4-6, 6-9, 9-14, and &gt; 14 transplants. We evaluated specific variables, including those identified as significant risk factors in previous PHTS studies including mechanical ventilation, PRA &gt; 10%, high BUN, gender, and Fontan completion, within each group. We used Kaplan Meier for survival, contingency tables with Pearson Chi-square test for association, and analysis-of-variance to compare means. P&lt; 0.05 was considered statistically significant. Results: There were 6800 cases among 55 centers. Table 1 demonstrates that there was no significant difference in one-year post transplant survival among the groups, and the patient variables showing statistically significant differences followed no specific pattern among the center volume groups. It also demonstrates that there is no clear association between cumulative risk factors within individual patients and center volume. Conclusions: One-year post transplant survival is similar within the PHTS for all centers regardless of case volume. These group differences were different for different variables and did not segregate consistently between lower volume and higher volume groups suggesting there exists a complicated relationship among risk factors and center volume.

The Social Distance Scale (v1): A Screening Instrument to Assess Patient Adherence to Prevention Strategies during Pandemics.

Background: This paper describes the development of a brief self-report screening measure of adherence to social distancing and self-protective behaviors in pandemic situations. Items measured behaviors currently established as primary strategies to prevent and reduce the spread of the COVID-19 infection. Methods: An item pool of 29 questions was generated with the aim of estimating the frequency of specific behaviors and were written to avoid confounding the description of behavioral actions with evaluative judgements. Responses were collected from 401 young adults using an anonymous online survey. Results: An Exploratory Factor Analysis was conducted with the purpose of item reduction and subscale development. A 14-item Social Distance Scale emerged, consisting of four subscales: Isolation from Community (IC), Work from Home (WH), Family Contact (FC), and Protective Behaviors (PB). The initial psychometric evaluation of the scales indicated adequate internal consistency and test-retest reliability. (4) Conclusions: The Social Distance Scale (v1) is a promising new instrument which may be applied at the population or individual level. It may be used in conjunction with COVID-19 testing to measure interactions between social distancing factors and transmission. In addition, a reliable screening measure has utility for health service providers to assess patient risk and to provide educational/counseling.

Consent in forefoot surgery; What does it mean to the patient?

AimsThis study aimed to assess patient risk recall and find risk thresholds for patients undergoing elective forefoot procedures. MethodsPatients were interviewed in the pre-assessment clinic (PAC) or on day of surgery (DOS); some in both settings. A standardised questionnaire was used for all interviews, regardless of setting. Patients were tested on which risks they recalled from their consent process, asked for thresholds for five pre-chosen risks and asked about a sham risk. ResultsAcross all interviews, risk recall on DOS (2.34 risks/patient interview) was significantly lower (p=.05) than in PAC (2.95 risks/patient interview) – this was repeated when comparing results from patients interviewed in both settings only with PAC mean recall of 2.93 risks/patient interview and DOS mean recall of 2.57 risks/patient interview. The mean reported risk thresholds greatly exceeded NHS Lothian’s observed complication rates for forefoot procedures. The five risks tested for thresholds produced the same order in each interview setting, suggesting a patient-perceived severity ranking. Patients answering the sham risk question incorrectly tended to recall fewer risks across all interviews. ConclusionsThis study shows that patient risk recall is poor, as previous literature outlines, reinforcing that consent process improvements could be made. It also illustrates the value of PAC visits in patient education, as shown by higher levels of recall when compared to DOS.

Development and validation of a knowledge-driven risk calculator for critical illness in COVID-19 patients.

Facing the novel coronavirus disease (COVID-19) pandemic, evidence to inform decision-making at all care levels is essential. Based on the results of a study by Petrilli et al., we have developed a calculator using patient data at admission to predict critical illness (intensive care, mechanical ventilation, hospice care, or death).We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7%–99.9%; specificity: 81.9%, 95% CI, 74.1%–88.2%). Of 127 patients with non-critical illness, 104 were correctly identified.Our results indicate that published knowledge can be reliably applied to assess patient risk, potentially reducing the cognitive burden on physicians, and helping policymakers better prepare for future needs.

Observational study of SARS-CoV-2 antibody immune response in a cohort of patients at a North Suburban Chicago, Illinois, in a physician’s practice

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The application of point of care serological testing can help determine past infection and assist healthcare workers assess patient risk. Method: An observational study of 114 subjects in North Suburban Chicago, Illinois, was performed using the Clungene® lateral flow immunoassay (LFI). Patients’ PCR test results and clinical symptoms were used to compare the seroconversion rate of this patient population with the surrounding community. Results: Excluding 1 aberrant result, there was 100% positive agreement (10) between PCR and antibody (IgG or IgM) test results. There were 7 patients who did not have a prior PCR test who were positive for IgG; 5 of the 7 had clinical symptoms consistent with possible exposure and 2 were asymptomatic. There was 1 person with a suspected exposure to an infected person who was IgM positive. Ninety-five asymptomatic patients were seronegative. The overall rate of 15.9% seroconversion (IgG or IgM) is consistent with other community-based testing results in the North Suburban Chicago, Illinois area. Conclusion: Rapid screening tests to identify antibody positive patients recovered from coronavirus disease-2019 can be a useful tool for healthcare professionals to determine or confirm past infection. Statement of novelty: Limited data is available on the use of point of care serological testing to assist healthcare professionals with the assessment of their patient population regarding past SARS-CoV-2 infectivity and seroconversion. The present study successfully investigated the use of a point of care antibody test in a physician’s office to determine which patients have developed antibodies, indicating an immune response to SARS-CoV-2, and to assist with decisions on whether patients should pursue normal social and workplace activities.

An assessment of baseline risk factors for peripartum maternal critical care interventions

Background Maternal morbidity presents a growing challenge to the American healthcare system and increasing numbers of patients are requiring higher levels of care in pregnancy. Identifying patients at high risk for critical care interventions, including intensive care unit admission, during delivery hospitalizations may facilitate appropriate multidisciplinary planning and lead to improved maternal safety. Baseline risk factors for critical care in pregnancy have not been well-described previously. Objective This study assesses baseline factors associated with critical care interventions that were present at admission for delivery. Study design This is a secondary analysis of a multicenter observational registry of pregnancy after prior uterine surgery and primary cesarean delivery. All women with known gestational age were included. The primary outcome measure was a composite of critical care interventions that included postpartum intensive care unit admission, mechanical ventilation, central intravenous access, and arterial line placement. Risk for this critical care outcome measure was compared by selected baseline and obstetric characteristics known at the time of hospital admission, including maternal age, pre-pregnancy BMI, race, maternal co-morbidities, parity, and plurality. We evaluated these potential predictors and fit a multivariable logistic regression model to ascertain the most significant risk factors for critical care during a delivery hospitalization. Results 73,096 of 73,257 women in the parent trial met inclusion criteria, of whom 505 underwent a critical care intervention (0.7%). In the adjusted model, heart disease [aOR = 10.05, CI = 6.97 − 14.49], renal disease [aOR = 2.78, CI = 1.49 − 5.18], and connective tissue disease [aOR = 3.27, CI = 1.52 − 6.99], as well as hypertensive disorders of pregnancy [aOR = 2.04, CI = 1.31 − 3.17] were associated with the greatest odds of critical care intervention [p < .01] (Table 2). Other predictors associated with increased risk included maternal age, African American race, smoking, diabetes, asthma, anemia, nulliparity, and twin pregnancy. Conclusion In this cohort, women with cardiac disease, renal disease, connective tissue disease and preeclampsia spectrum disorders were at increased risk for critical care interventions. Obstetric providers should assess patient risk routinely, ensure appropriate maternal level of care, and create multidisciplinary plans to improve maternal safety and reduce risk.